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I just got back from the annual American Academy of Dental Sleep Medicine conference and was amazed at the amount of new research being done regarding sleep. I took a ton of notes and want to share everything I learned with you, but I think it will be too overwhelming for one blog so I am going to divide it up over the next few weeks.
I'm going to do a series that addresses the following topics:
• general information related to sleep
• children and sleep
• geriatrics and sleep
• diseases associated with sleep disturbances
First, I'll answer the question that many people ask me: why, as a dentist, do you even care about sleep? Very simply, we all need sleep and when it's interrupted, for whatever reason, it affects our overall health dramatically. Because our practice focuses on prevention and education, we discuss sleep with our patients. Additionally, dentists are in a unique position to work with sleep physicians in making oral appliances that eliminate snoring and treat obstructive sleep apnea (OSA).
One of the most common sleep disorders is obstructive sleep apnea, a condition where breathing is interrupted many times a night due to a blockage or collapse of the airway. People may stop breathing for 10-60 seconds, hundreds of time a night. This stoppage leads to problems in many areas of the body and is linked with an increased risk for: high blood pressure, depression, stroke, diabetes, metabolic syndrome, heart failure and impotence. OSA is treated with either a mask called CPAP that blows air and prevents collapse of the airway or an oral appliance that repositions the jaw and opens the airway.
Interesting new research shows:
• OSA patients treated with either oral appliance therapy or CPAP were able to reduce their high blood pressure medications after one year of use. Because high blood pressure is common with OSA, I always suggest that patients with it evaluate their sleep to determine if they have OSA.
• Custom-made oral appliances to treat both snoring and sleep apnea fit better and, therefore, are more comfortable. The reason this is important is because the more comfortable the appliance, the more compliant a person will be in wearing the appliance.
• People who suffer from sleep disorders are more sensitive to pain. This is especially important for chronic pain sufferers - perhaps correcting sleep patterns will decrease pain levels.
• Excessive wear on front teeth can happen at night while a patient is struggling to sleep. Many people deny being aware of grinding their teeth but still have wear. OSA may be the cause.
OSA is not the only sleep disorder that exists and without an evaluation by sleep physician, and many times an overnight sleep study, it is impossible to diagnose what is wrong. Other sleep disorders include restless leg syndrome, insomnia, delayed sleep response and chronic partial sleep deprivation. Some signs that point to a sleep disturbance are:
• Difficulty falling asleep or staying asleep
• Daytime sleepiness
• Depression
• Loud snoring that disturbs the sleep of others
• Difficulty concentrating
• Gasping for air during sleep
• Waking up with a bad taste in your mouth
• Chronic morning headaches
If you believe you have issues with sleep, I suggest contacting a sleep physician or discussing your concerns with your doctor.
For more information, visit: http://www.aadsm.org/whatisdentalsleepmedicine.aspx, http://www.ahsleepcenters.com/
For any additional questions, please contact our office at 973-377-6500 or info@adamsdentalnj.com.

I had a new patient in yesterday who works at a big pharmaceutical company and is involved with sustainability at their company. It made me think about what, if anything, we do to support sustainability. At first, all I could think of was recycling our paper and plastic, and I was a bit embarrassed. But the more I thought about, I realized that small changes we’ve made over the years have been “green”:
• Digital x-rays – I think this is the single biggest change because it is such a win-win for everybody. Using digital allows us to dramatically reduce radiation exposure for patients. Also, the system has a reusable sensor which eliminates the need for film and its lead lining. Finally, no chemicals are needed to develop the film.
• Appointment reminders – we decided a few years ago that we wanted to reduce the amount of paper we use at the office, so we switched to an email or text appointment reminder system. We no longer send out postcards which saves paper and printer ink.
• Communication – let’s face it, no office will ever completely eliminate paper use, but little changes make an impact. We use email now to communicate with doctors, labs and patients. All referral letters and x-rays are sent over the internet instead of being printed and mailed. The additional plus side is that I’m amazed at how little stationary I need to purchase!
• Plastic containers – our sterilizers require distilled water and each week we would go through at least five plastic jugs. Installing an automatic distilled water system in the office has eliminated the waste of plastic (and makes my assistants happy because they don’t have to lug jugs of water around).
• Construction – we recently renovated a building for our office and although we made big changes, I tried as much as possible to reuse or maintain building materials. Windows and wood trim could have been replaced, but we chose to keep them. When we purchased things for the building, we looked for sustainable or energy efficient supplies like fluorescent lighting, Energy Star® products, and products made with recycled materials.
While I’m sure there are more things we could do at the office, I’m pleased that we’ve done some things to make an impact. I encourage everyone, home and business alike, to spend some time recognizing the changes you’ve already made and considering the additional things you can do to improve sustainability.

Madison Dentist Now Screening & Treating Patients For Obstructive Sleep Apnea
Madison, NJ — New Jersey dentist Dr. Samuel Romano, who’s office is located at 120 Park Avenue, is treating patients with obstructive sleep apnea. Patients now have the opportunity to be screened for this disease in the luxury of their own home.
Obstructive Sleep Apnea, or “OSA” for short, is a chronic sleep disorder that is characterized by abnormal pauses during breathing. Those affected with OSA can stop breathing hundreds of times throughout the night, depending on the severity of their condition. Symptoms of OSA include: snoring, excessive daytime fatigue, morning headaches, forgetfulness, insomnia, moodiness and irritability, difficulty concentrating and gastrointestinal reflux. As the untreated sleep apnea progresses, it may lead to more serious medical conditions including: cardiovascular disease, stroke, diabetes, and heart attacks.
Dr. Sam Romano can treat the overall health of his patients with the help of state of the art technology. With diagnostic testing, personal evaluation and sleep study results, Dr. Sam Romano can customize an oral appliance designed specifically for you.
After your sleep study has been evaluated, Dr. Sam Romano will know the degree of your obstructive sleep apnea. Based upon your test results, if appropriate, Dr. Sam Romano then fabricates an oral appliance for patients to wear at night, to maintain optimum oxygen levels. This appliance is designed to keep the airway from collapsing. Patients are highly compliant with oral appliance therapy because of the ease of use and immediate relief it provides. The sleep study is then repeated with the use of oral appliance therapy, to demonstrate the effectiveness of the device. The resulting report gives us affirmation that the appliance in place is effectively treating the OSA.
Dr. Sam Romano, DMD:
“My vision is to change the way you perceive dentistry and to improve your quality of life”, Dr. Sam Romano states. “The addition of sleep apnea therapy into my practice gives me the opportunity to enhance my patients overall health, which is very important to me.” Dr. Sam Romano has been in practice for 27 years at the same location-120 Park Avenue, in Madison. Dr. Sam Romano can be reached at 973-377-7088, via his website: www.drsamromano.com or you can visit his facebook page at: www.facebook.com/drsamromano.
Dr. Sam Romano is a member of the American Academy of Cosmetic Dentistry. He is also a clinical instructor at the world renowned Kois Center, a state of the art, post graduate, dental teaching facility, in Seattle, Washington. Dr. Sam Romano enjoys teaching dentists, from all over the world, advanced techniques in general, restorative, and cosmetic dentistry. He is a lifelong resident of Madison where he resides with his wife and two children. Dr. Sam Romano is an active member of his community.

Most people don’t think their family dentist could save their life, but the truth is that they can. This year over 52,000 Americans will be newly diagnosed with oral and throat cancers. When detected in the early stages of disease, these cancers have an 80– 90% chance of survival. However, the reality is that most of the cancers won’t be diagnosed until later stages the person will not live longer than five years after the initial diagnoses.
Since April is national Oral Cancer Awareness month, I thought it was important to review the risks and signs of oral cancer.
It is important to know the risks for developing oral and throat cancers. The most obvious of risks are smoking and drinking alcohol over a long period of time. Another risk is the HPV-16 virus (human papilloma virus). This is the same virus associated with cervical cancer in women. If you or your partner/spouse has a history of HPV, your risk for developing throat cancer may increase. It is known that men have a three times greater chance of developing throat cancer due to the HPV virus than women. There are a small percentage of people (about 7%) who develop oral and throat cancers with no apparent cause. In these cases it is believed that a genetic predisposition may exist.
There is no age discrimination when it comes to oral and throat cancer. These cancers can affect anyone at any age. The following list contains the signs and symptoms that can be associated with oral and throat cancer:
- A sore or lesion that does not heal within two weeks
- A white or red patch on the gums, tongue, tonsil, floor of the mouth, inside of the cheek
- A lump or thickening of the cheek
- Difficulty chewing or swallowing
- Persistent sore throat, hoarseness, or changes in your voice
- Difficulty moving the jaw or tongue
- Swelling of the jaw that can cause a denture to fit poorly
- Persistent swollen lymph nodes under the chin and along the sides of the neck
Each year the death rate for these cancers continues to grow. By raising awareness and knowing your risks for developing the disease we can decrease the death rate and increase the survival rate.
Please know your risk for developing oral and throat cancer. Discuss your risks with your dental team and ask your family dentist for a head and neck cancer screening at every visit that may include use of the VELscope, a special non-invasive light that evaluates the cells below the surface. Your dentist should exam your lips, tongue, throat, gums and feel your lymph nodes. It only takes 4 minutes and it could save you life.

He Snored Last Night! No! She Snored Last Night! No Snoring Please!
As the father of a third grader, I try to use some of the teachings from my son’s homework and apply them to some of our everyday life’s teachings. Here is an acrostic poem to think about:
A little test you or your snoring partner can take.
S (Snore) Do you snore loudly, (louder than talking or loud enough to be heard through closed doors?)
T (Tired) Do you often feel tired, fatigued, or sleepy during daytime?
O (Observed) Has anyone observed you stop breathing during your sleep?
P (Blood Pressure) Do you have or are you being treated for high blood pressure?
B (BMI) BMI more than 35 kg/m?
A (Age) Age over 50 yr old?
N (Neck Circumference) Neck Circumference greater than 40 Cm (16 in)?
G (Gender) Gender male?
High risk of Obstructive Sleep Apnea: answered yes to three or more items
Low risk of Obstructive Sleep Apnea: answered yes to less than three items
Snoring is not to be Ignored.

I recently sent an email to my three children (ages 18, 19 and 26) with the subject line “An important topic no one wants to talk about” that had them jokingly saying they were going to mark future emails from me as Spam. The unpleasant topic was related to the correlation between HPV (human papillomavirus), oral cancer and oral sex.
HPV is the broad term for a group of viruses, some of which are considered “low risk” and others which are “high risk” and cause genital cancers. HPV-16 is the strain that causes both genital and oral cancers.
In the past, the “model” for oral cancer was an older man who had spent a lifetime of smoking and drinking. But now, young people without the risk factors of smoking and drinking are being diagnosed with oral cancer. It is suspected that oral sex, considered by many young adults to be “safer” than intercourse, is considered the culprit.
According to the Journal of the American Medical Association, about 7 percent of men and women between the ages of 14 and 69 living in the United States carry HPV in their mouths. Advances in diagnosis have allowed researchers to test for viral DNA and have found HPV in many oral cancers. Even the location of HPV related oral cancer varies from the “traditional” oral cancers, with lesions being found primarily in the back of the throat and in the crypts, or crevices, of the tonsils.
I advise all my patients to be aware of the potential signs and symptoms of oral cancer:
A unexplained white or red lesion in the mouth that is present for more than two weeks.
A swelling in the throat
Difficulty or painful swallowing
A change in your voice
If you notice any of the above, call us for a complete evaluation.
Oral sex is not the only cause of transmission; HPV infection increases with the number of partners you have and is transmissible by skin to skin contact. Not all infections with HPV will lead to cancer. Of the 150 related viruses, about 40 are sexually transmitted and only some of those will cause cancer. Most infections with HPV are cleared by the body without any long term consequences.
If you would like additional information about HPV and cancer, visit our website at www.adamsdentalnj.com or contact our office at 973-377-6500. Additional information is available on the websites below.
http://abcnews.go.com/Health/ReproductiveHealth/hpv-oral-cancers-rise-oral-sex-popular-spread/story?id=11916068#.T2Ozo8WPUTY
http://www.cancer.gov/cancertopics/factsheet/Risk/HPV
http://oralcancerfoundation.org/facts/index.htm

Just about everyone snores occasionally. Even a baby or a beloved pet may snore! However snoring can affect the quantity and quality of your sleep. Poor sleep can lead to daytime fatigue, irritability, poor behavior, trouble with relationships and increased health problems.
Sleep also affects your mood. People who chronically lack sleep are also more likely to become depressed. Sleep disorders deprive you of a “good night’s sleep”, chronic daytime exhaustion, and long-term cardiovascular stress.
Snoring is a most common problem plaguing the world. Studies show that almost 46% of the male and 30% of the female populace in the world snore on a regular basis. The question remains as to how snoring can affect your marriage. For many it most certainly can. But before diving into that topic, let us first know what is snoring.
If you snore regularly and experience these symptoms, you may have a condition called sleep apnea. It is as widespread as Asthma and Diabetes; however sleep apnea often remains undiagnosed.
What is sleep apnea?
Under normal conditions, the muscles that control the upper airway relax during sleep. If they relax too much, the upper airway becomes narrow and some people begin to snore. If the airway becomes to narrow, this may cause difficulties in breathing. Sometimes the airway becomes completely blocked and the person temporarily stops breathing – experiencing obstructive apnea. Apnea means without breath. This can last for 10 seconds or more. It may happen frequently or even several hundred times a night.
If you have this condition, every time an apnea occurs, you struggle to breathe, placing stress on your brain and heart.
Research shows that snoring and sleep apnea are associated with many serious conditions. Left untreated, they are a contributing risk factor in high blood pressure, heart disease, stroke diabetes and depression.
So don’t IGNORE the symptoms if you SNORE.
To learn more about snoring and sleep apnea visit www.drsamromano.com

How Vitamin D Affects your Body and Dental Health
This past year one of my patients, at our Madison, NJ office, had a small basel cell removed. Being fair she has always tried to protect her skin from the sun. The advice of her surgeon was to stay out of the sun. A recent routine blood test indicated that her Vitamin D level was deficient. It was interesting that all her medical doctors told her to avoid the sun but none, until the blood test, told her about supplementing her Vitamin D intake. As a dentist, we care about our patients overall health as well as their Dental Health.
Vitamin D’s health benefits have been in the news a lot lately. I took the time to understand the effects of Vitamin D on dental health. I want to share some information I have learned with all of my dental patients and more.
Many people understand that Calcium helps build strong bones ands teeth. However, most probably don’t know the relationship Vitamin D has with Calcium and your dental health. So, what does Vitamin D do for the body? Vitamin D helps our bodies absorb the calcium we need for optimal bone and teeth development. Without enough Vitamin D in childhood, bone deformities can develop. If we do not get enough in our adult life it can lead to reduced bone density, osteoporosis & increased risk of bone fractures.
The latest research suggests that Vitamin D plays a role in helping to prevent a variety of health conditions, including multiple sclerosis. It can also reduce the risk of breast cancer in women. So you are probably wondering, what about how it benefits your mouth? The importance of Vitamin D for your teeth is very significant and almost completely overlooked in the medical field. How often have you been told to take Vitamin D for the prevention of periodontal/gum disease and the formation of cavities? Probably not very often. Since we were kids we have heard about the importance of Calcium, but, the relationship of Vitamin D is just as important. For many of our patients, brushing regularly, flossing daily and seeing our dental hygienist twice a year hasn’t always stopped all of periodontal disease. As a dentist this is very discouraging.
When patients suffer from this disease they have a weakening of the bone that anchors teeth into their socket. This leads to redness, bleeding, inflammation (also known as gingivitis), which if untreated can eventually lead to loss of teeth. Vitamin D is also important because it acts as an anti-inflammatory. It is an important stimulator of our immune system. When your immune system health is at its best, you are less likely to get bacterial infections in your gums and elsewhere.
So how does it all work? Calcium is stored in bones and teeth. This stored nutrient is always in a state of movement. When the body needs more Calcium in the bloodstream due to low levels, the body extracts it from its storage in bones and teeth. When there is an abundance of Calcium in the bloodstream, it is put back into bones and teeth, thus making our skeleton very strong and resilient. Vitamin D acts as the regulator of this whole process. When Vitamin D levels are too low, no Calcium is put back into bones and teeth. Then our bones become weakened and susceptible to fractures. Low levels of Vitamin D can be a contributing factor to osteoporosis and periodontal disease.
To sum it up, Calcium and Vitamin D are critical for the general health and strength of bones and teeth. With the avoidance of sun exposure many people are becoming Vitamin D deficient. In the case of my patient, once skin cancer was detected, and the recommendation to stay out of the sun was made, the importance of supplementing Vitamin D was not suggested.
It is very important to make sure we get enough Vitamin D in our diet and from supplements. It is recommended to take 1,000 IU of Vitamin D daily for adults and 400 IU for children. Eating foods high in Vitamin D is also helpful. Such foods include milk, yogurt, salmon, orange juice, tuna, eggs, and cheese.
If you would like more information on how Vitamin D affects your mouth or your overall health please contact me atdrsam@drsamromano.com or visit our website at www.drsamromano.com

For years, dentists have known that oral health and overall systemic health are linked. Now, more and more research recognizes the significant link between diabetes and periodontal (gum) disease.
Diabetes is a disease that affects the body’s ability to fight infection and diabetics are more prone to develop gum disease. Inflammation, and the destruction that occurs as a result of it, is a key factor in the development and progression of both diabetes and gum disease. Diabetics may have difficulty controlling their blood sugar levels, even with medication, if they have uncontrolled gum disease. Conversely, patients with gum disease, even those who are undergoing treatment for it, may find their efforts unsuccessful if they lack glycemic control.
If you are diabetic, you should see your dentist regularly. You may need to have cleanings done more frequently depending on the condition of your gums.
Signs of gum disease:
• Red, swollen gums
• Gums that pull away from the teeth
• Bleeding gums with brushing and flossing
• Bad breath
• Teeth feel like they don’t fit together properly
If you have any of the above signs, regardless of whether or not you are diabetic, you should see your dentist for an evaluation.
The good news is that both physicians and dentists are aware of the relationship between these two diseases and will work with one another to co-manage a patient’s care.
For more information, please visit our website at www.adamsdentalnj.com or email us at info@adamsdentalnj.com.